There is evidence that hospitable and calming healthcare environments can actually contribute to how quickly patients recuperate and how well staff provides care. Key components of these spaces are warm interior colors, comfortable furniture, beautiful artwork, daylighting, quality artificial lighting, reduced noise levels, improved wayfinding, and a connection to nature. In 1984, Dr. Robert Ulrich (now the Director of the Center for Health Systems and Design at Texas A&M) pioneered the notion of correlating patient recovery and the environment. Today, sources in the fields of design and healthcare credit a less stressful, more relaxing atmosphere with faster recovery, reduced hospital stays, less need for pain medication, and improved staff performance.1,2,3 Encouraged by these findings, large hospitals and small ambulatory centers alike, regardless of budget, are adopting this design approach at various levels.

Daylighting and fixtures with low-glare luminaires and high-color-rendering sources applied to approximate the qualities of natural light help establish that essential connection to nature.

Visual ergonomics are also important in healthcare lighting plans. For instance, direct-indirect fluorescent lighting in corridors reduces the glare caused by some recessed downlights, which can be uncomfortable for patients in a supine position and stressful for nervous patients and anxious visitors. Well-placed indirect lighting can also emphasize destination nodes and offer subliminal wayfinding cues-critical goals for hospital planners.

Likewise, more hospitable patient rooms are in demand. In Steffian Bradley Architects' recently completed addition to Milford–Whitinsville Regional Hospital in Massachusetts, the artificial lighting in the new patient rooms is comprised of direct-indirect fluorescent wall sconces (next to the pull-out visitor's couch) and custom-built, multi-level wood valances (controlled via pillow-talk remotes). User-controlled stepped lighting allows a patient or staff member to dial up a light level that is suitable for them. Prismatic lens fixtures in the patient-wing corridors have been replaced with less institutional, dual-switched or dimmable indirect fluorescent sconces and low-glare recessed downlights.

Quality lighting is critical in support spaces (such as doctor suites and staff lounges) as a way to promote employee well-being. In the award-winning D'Amour Center for Cancer Care in Massachusetts (see A|L, July/August 2004), natural lighting is maximized in public 'living rooms,' infusion treatment areas, staff workspaces, and lounges. Sunlight is supplemented with integrated indirect coves (to enhance luminance balance) and accent lighting to emphasize nature-themed artwork. In 24-hour facilities, fixtures in staff areas are specified with either dimmable or multi-switching options to allow users better control of lighting levels depending on the time of day or climatic conditions. Nurses' stations are fitted with indirect fluorescent coves to increase surface luminance and improve visual acuity and alertness.

Lighting has also become a consideration in special care nurseries (SCN) for pre-mature babies. In the Journal of Pediatrics' February 2002 issue, researchers from Duke University noted that cycle-light exposure helps pre-term infants 'grow faster' (thereby developing their immune system quicker), which may reduce the risk of pre-term complications. At present, there is no consensus about what constitutes the ideal lighting environment for SCNs and well-baby nurseries. Although the delicate visual system of the pre-term newborn cannot handle intense light or exposure to UV or IR radiation, SCN units have been developed that allow diurnal-cycle (daylight) illumination at conservative levels.

A soothing environment is uniquely essential in psychiatric units, but there are few 'welcoming' options among available security fixtures. However, creative designers are integrating multi-level or dimmable fluorescent lighting into custom millwork in order to meet both recommended healthcare safety standards and needs of the patients and staff.

Medical facilities designed to create a healing environment are likely to proliferate in a market where an increasingly informed public prefers a less institutional atmosphere. In a heavily competitive field for recruiting and maintaining well-trained staff, these types of environments can also help draw and keep personnel.2 The future looks bright for quality lighting in healthcare!

enrique rojas, a member of the IALD and a senior associate at Steffian Bradley Architects in Boston, is an award-winning international lighting designer with experience in daylighting, and architectural and urban lighting design.